Should you be eating that, it’s full of sugar?Feel guilty every time you enjoy something sweet? Do you think having diabetes equals no sugar? Join the club. Not only that, if you have diabetes, you have probably been on the receiving end of an accusing: ‘Should you be eating that, it’s full of sugar?’ Or ‘I thought sugar was to be avoided like the plague.’ It’s not only irritating, it’s outdated (the sugar taboo was based on experiments on dogs in the 1920s). But old habits die hard. And be grateful the Diet Police didn’t grab that lifesaving lolly or sweet drink out of your hands while you were having a hypo.

Photo: Ian Hofstetter

One of the happy spin-offs of glycemic index research has shown that most sugars in foods produce quite moderate blood glucose responses, lower than most starches. Why? Well sugars (including sucrose/table sugar GI 60) are a mixture of molecules, some of which have only a negligible effect on blood glucose levels. Many scientific studies clearly show that a moderate amount of sugar in diabetic diets (for example 30–50 grams or 6–10 teaspoons) does not lead to poor blood glucose control nor weight gain. Keep in mind, however, that this moderate amount includes all sources of refined sugar you consume – white, brown, raw, treacle, golden syrup, soft drinks, desserts, cookies breakfast cereals or a teaspoon of sugar added to a cup of tea or coffee.

When you want a little sweetness in your life, opt for nutritious foods that will provide more than calories – porridge with brown sugar, a dollop of jam on grainy toast, muesli with fruit yoghurt, a scoop of low fat ice-cream with a baked apple. And it’s OK to enjoy a treat occasionally too, such as two or three squares of good quality chocolate.

What does 40 grams of added sugar look like in a healthy diet?Diabetes dietitian Kaye Foster-Powell shows us what 40 grams of added sugar looks like in a healthy diet for someone with diabetes.

Photos: Scott Dickinson

Nutritional analysisThe total energy content is 1520 calories (6400 kJ) with 22% energy from fat and 55% from carbohydrate. The fat content is 38 grams. The total carbohydrate content is 220 grams with 112 grams from starch and 108 grams from sugars (added plus naturally occurring).

The perils of iron overloadIt’s well known that a chronic shortage of iron leads to anaemia. Too much iron can cause problems, too. Researchers writing in the January issue of Diabetes Care found that a high iron intake was associated with heart disease in women with diabetes. The researchers followed up 6,161 women from the Nurses' Health Study with type 2 diabetes over 20 years to investigate the relationship of dietary iron and red meat to heart disease. After accounting for age and body weight, the researchers found that the women who had the highest intake of heme iron and red meat had a 50 per cent greater risk of developing heart disease than those with the lowest intake, especially if they were postmenopausal. The writers conclude that to prevent heart disease: ‘patients with type 2 diabetes may consider reducing their consumption of heme iron and red meat’.– Diabetes Care 30:101-106, 2007

Hemoglobin model

GI Group: There are two dietary sources of iron that our bodies can use:

Heme (haem) iron from animal foods such as meat, chicken, fish and offal

If you have type 2 diabetes and you love your red meat, there’s no need to give it up. Just be quite moderate with the amount you eat as the researchers suggest. Did you know that 100 grams (3½ oz) of lean meat as part of a balanced diet will meet the daily nutrient needs of an adult?

When cloudy is better than clearResearchers at the Agricultural University of Wroclaw have found that cloudy apple juice can have up to four times more antioxidants than clear because of the manufacturing process. The potent antioxidants in apples are polyphenols – also found in red wine, berries and dark chocolate. The scientists measured the amount of procyanidins, the main compounds that contain polyphenols, in two varieties of clear and cloudy apple juices. The cloudy apple juice, which contains more pulp, had higher concentrations of antioxidants and showed more antioxidant activity. They also found the same results for clear and pureed or cloudy strawberry juices.– Journal of the Science of Food and Agriculture

GI Group: The apple juices GI-tested to date all have a low GI (37–44), but the cloudy juice, Wild About Fruit Apple Juice with Fibre, was the lowest. Remember a serve is a small glass, around 200 ml (7 fl oz).

Reducing the risk of dementiaIs insulin resistance a modifiable midlife risk factor for dementia? A new study published in the December issue of Diabetes Care reports that hyperinsulinemia is linked to cognitive decline. Hyperinsulinemia is a condition when the level of insulin in the blood is higher than normal. It is caused by overproduction of insulin by the body and is related to insulin resistance. The researchers from the Medical University of South Carolina examined 7148 healthy adults who were given a series of cognitive tests at the outset and followed up six years later. They report that those with the highest level of insulinemia had the significantly greater declines in delayed word recall and first letter word fluency.– Diabetes Care 2006;29.2688-93

Setting GI labelling standards in AustraliaIn a world first, Standards Australia have released a standard for use by food manufacturers, accreditation bodies, regulators, educational institutes, testing laboratories, and research organisations that sets out a recognised scientific method for determining the GI of carbohydrates in foods.

What does it mean? It doesn't change the GI in anyway, but it does stop manufacturers from making false claims about the GI on their product labels and in advertising and marketing. Australian consumers can now be confident that if the label says a food is 'low GI' then it really is low GI, and it really has been tested by an accredited laboratory such as Sydney University Glycemic Index Research Service. For a list of accredited laboratories around the world see 'GI Testing' in the right-hand column. If you head over to the SAI Global WebShop, you can buy a copy of the standard for GI testing (insert 'glycemic index' in the search box). The standard has been submitted to the International Standards Organisation for possible adoption by other member countries around the world, so eventually consumers in the United States, Canada and Europe and other parts of the world may benefit from this initiative.

FructoseFructose is a sugar that’s abundant in nature – you’ll find it in fruit, berries and honey. It has provided humans with carbohydrate energy for millions of years. As a product today it stands out from the crowd of alternative sweeteners, being sweeter than sugar (it depends on the temperature, the colder the better), providing the same amount of calories, but having only one-third the GI (19). This means you can use less fructose to achieve the same level of sweetness, and as a result, consume fewer calories and experience a much smaller rise in your blood glucose levels.

Photo: Ian Hofstetter

The most recent study published in the American Journal of Clinical Nutrition (2006;84:1374–9) found that a 4-week high fructose intake by a small group of healthy men did not lead either to an increase in body fat or insulin resistance. But there’s no doubt that fructose consumption per capita has increased in recent decades as it is more widely used by manufacturers for sweetening beverages and foods. Here are answers to some of the questions we are most frequently asked about fructose.

How come fructose has a low GI?Fructose (GI 19) is absorbed and taken directly to the liver where it is immediately metabolised.

The food industry will lower the GI by using fructose or adding fatIt hasn't happened in Australia to date. For example, there are over 100 products in the GI Symbol Program. Manufacturers could use fructose if they wanted to, but to date there’s only one, a low kilojoule sports water, with 3 per cent fructose in it. And if a food was high in fat, it wouldn’t be able to carry the symbol as products with the GI symbol must meet a host of strict nutrient criteria including calories/kilojoules, total and saturated fat, sodium (salt) and where appropriate fibre and calcium. For more information: http://www.gisymbol.com.au/

What’s high fructose corn syrup (HCFS) and why is it a problem?Corn syrup solids’ are often found on the labels of American foods. They are the most common form of sweetener in North America because they are cheaper than cane sugar. They are made from corn starch by enzymatic or chemical treatment. Further treatment produces HCFS solids which are very sweet and contain roughly 50 percent glucose and 50 per cent fructose. They are the main source of sweetness in soft drinks made in the United States and Canada. Although the name implies they are high in fructose, they yield the same number of fructose molecules as cane sugar during digestion and absorption.

I have fructose malabsorption. How can I eat a balanced diet since a lot of fruit and veggies seem to be ruled out?If you have fructose malabsorption it means that the small intestine is impaired in its ability to absorb fructose which then passes through to the large intestine where bacterial fermentation can cause symptoms such as bloating, wind, pain, diarrhoea and/or constipation says IBS specialist dietitian Sue Shepherd. The good news is that foods with more fructose than glucose tend to be the problem, as are foods with a lot of fructose (regardless of the amount of glucose). To make sure you are eating a balanced diet, see a dietitian. And if you want recipes, check out Sue Shepherd’s website. She has self published two ‘Irresistible for the Irritable’ cookbooks that will be helpful: http://www.coeliac.com.au/

Is it true that if fructose is consumed after eating a large meal that overly raises the blood glucose or with high glycemic foods, it no longer has a low glycemic value as it takes on the value of the high glycemic foods?This is not correct. Fructose mixed with a high GI meal gives you something intermediate between the two.

Apple and polenta crumbleThere's nothing more comforting than apple crumble, yet sadly for those who are gluten intolerant, even one made with oat flakes is unapproachable. Here's a low GI, gluten free alternative from Food Coach Judy Davie using polenta and while it may not have exactly the same consistency as traditional crumble made from flour, sugar and butter, it is better for you and will give you that same sense of nurturing and warmth. If you enjoy this and want to try more of Judy’s recipes, visit www.thefoodcoach.com.au

In a small pan combine the apple concentrate, tahini, water and oil and slowly bring it to the boil stirring continuously. Add the polenta; reduce the heat to low and simmer, stirring regularly for 10 minutes. Set aside to cool.

Arrange the apples in the bottom of a pie dish or individual ramekins, and sprinkle with cinnamon. Using your hands, crumble the polenta over the top. Bake for 30–35 minutes. Serve with yoghurt if you like.

GI Express: Penne with Tomatoes, Buffalo Mozzarella and Fresh BasilThis tasty recipe that’s on the table in less than 30 minutes is from The Low GI Vegetarian Cookbook. If you are unable to find buffalo mozzarella, substitute with bocconcini or fresh mozzarella. Or, to make a lower fat version if you prefer, use a reduced fat ricotta.Preparation time 10 minutesCooking time: 15 minutesServes 4

Cook the penne in a large saucepan of lightly salted boiling water according to the packet instructions or until just al dente. Drain, and keep warm.

Return the pan to a medium–low heat, add the oil and garlic and cook, stirring, for 30 seconds. Add the semi-dried tomatoes and cherry tomatoes, increase the heat to medium–high and cook, stirring, for 2–3 minutes, or until the cherry tomatoes are slightly wilted. Add the drained penne, and mix it well with the tomatoes and garlic.

Remove the pan from the heat, add the mozzarella, rocket, basil and lemon zest, and season with pepper.

GI Vegetarian: Bryanna Clark Grogan’s High protein oat wafflesIf you didn’t make these crisp, ultra-nutritious, low GI waffles yourself, you’d never guess you were eating beans! As there’s no added fat for cooking the waffles, make sure you use a good-quality, non-stick waffle iron. This recipe is from Dr Neal Barnard’s Program for Reversing Diabetes. For more information (and delicious recipes) visit: www.pcrm.org

The night before, place the beans in a large bowl and cover generously with water. Refrigerate overnight.

In the morning, drain the beans discarding the soaking water. Place in a blender with 2¼ cups fresh water and the oats, nectar, flaxseed, baking powder, vanilla and salt. Blend until smooth, light and foamy. Set aside and preheat a non-stick waffle iron.

Pour 1/3 cup of batter onto the hot waffle iron for each 10-cm (4-inch) waffle, close the iron and cook for at least 8 minutes. If the iron is hard to open, let the waffle cook for another minute or two.

Repeat with the remaining batter, blending briefly before pouring each waffle. If the batter thickens while standing, add just enough water to return it to its original consistency. The waffles should be golden brown and crisp. Serve immediately with your favourite toppings.

‘What a relief to finally understand why a little butter and sugar actually won’t kill you.’ – Jane‘For reasons unknown, my metabolism seemed to change and I put on an extra 15 kilos over 12 months when I turned 35 – without changing my eating habits. I trudged off to the nutritionist - had my hormones, thyroid, blood sugar, everything tested, but nothing was obviously amiss. So it was decided that I was an over-eater (which I knew was not the case-more like an occasional binge-potato-chip-eater - sound familiar?) and put on a strict calorie counted, portion weighed and measured diet. Apart from regularly almost fainting from the constant and gnawing hunger on this diet, I only lost 4 kilos in 6 months. The nutritionist got angry and said that I must be eating on the side and lying about my calorie intake, so needless to say I didn’t visit that person again!

Then while surfing the web, I discovered the whole low GI thing. I suffer from a number of food allergies as well and had always joked with friends that I was allergic to the 20th century! Now that I have started the GI way of eating, I discover that this is pretty true. Much ‘modern’ food, (read ‘processed’ food) has a high GI. So after studying the GI, and cutting out most processed food, anything that even slightly resembles potatoes and a number of other high GI foodstuffs, I have lost 7 kilos in 30 days with no effort at all. I eat whenever I’m hungry with naturally much smaller amounts because real food is so much more filling. I always had the feeling that my weight gains and fluctuations were linked to what I ate, not the quantity, and the low GI way of eating has helped me understand just how that works within me. I was a potato-high-carb junkie.

I am just back from a two-week exotic holiday where I paid 50 per cent attention to what I ate (still avoiding those spuds!) and I didn’t put on a single ounce, while still enjoying all the local delicacies. Now into my second month, I have just got the exercise bike up and will help myself even more by getting out of my modern sedentary style of life with time on the pedals every day.

My personal understanding is that basically, the low GI diet brings us back to a culinary point in our evolution that our bodies can still cope with. And what a relief to finally understand why a little butter and sugar actually won’t kill you ... it’s more likely the white bread and cookies that will be your real downfall! But no longer mine!’

‘I am in my mid-seventies, and feel renewed.’ – Karl‘As a physician I closely followed my blood chemistries and weight. At retirement my BMI was 26.5, body fat 25%, total cholesterol = 170, LDL/HDL = 2.5:1, triglycerides = 160, and HgbA1C = 6.3 - 6.6. After having a single stent placed in the LAD coronary artery, I became motivated to take control of those factors within my control. I discovered your website and obtained the recommended books and literature. After 18 months of maintaining a diet with a GI below 55, a GL at or below 80, limiting saturated fats, and consistently exercising with an output of 500 Kcal in each of two sessions a day, I have achieved an amazing improvement in wellbeing and energy. And I have the following bonus chemically. Body fat 17–18 per cent with lean weight gain of several pounds and a total weight loss of 25 pounds; HgbA1C = 5.6, total cholesterol = 115, LDL/HDL = 1:1, triglycerides = 60, and BMI = 24-25 (lean weight gain skews the BMI, and ageing reduced my height by 1.5 inches). Chemistries are important, but the most impressive is the activity level and sense of wellbeing. I am in my mid-seventies, and feel renewed. Thank you.’

Inspire others. Share your GI story.

We'll send you a free copy of The Low GI Diet Cookbook or The Low GI Vegetarian Cookbook if your story is published.

This book is about how you can work with your body to lose weight and keep it off. It’s not another diet book, in fact you can read it along with your favourite diet book be it a low GI diet, high protein or low carb. It’s by a molecular scientist who actually knows what it feels like to be fat. In her frank introduction to this book, Dr Amanda Sainsbury-Salis describes her own moment of truth: ‘After six years of dieting, I’d gained 40 kilos. I’d dieted myself fat.’ This was the moment she decided to use her scientific training as a biochemist to find a way to lose weight for good. For herself. And for everyone else in the same boat. The strategies she suggests in this book (and there are lots of them) worked for her. She lost 24 kilos in 2 years and 4 more kilos over the next 4 years. She has maintained this weight loss for 9 years. These strategies have also worked for her husband, many of her friends and hundreds of her clients.

Dr Amanda Sainsbury-Salis

During her research she discovered that the real enemy is a basic physiological phenomenon. Losing weight triggers a cascade of reactions in your body that makes it hard first to keep losing weight, and secondly to keep it off (sound familiar?). She calls this the Famine Reaction. It’s the mechanism that’s helped the human race survive famine and food shortages for millions of years. How to counteract it? That’s what this book is about. To tune into your body signals eat:

A large variety of whole (minimally processed) foods.

Mainly vegetables and fruits, the greater the variety the better.

Just enough to satisfy your physical hunger (ad libitum) and not stay hungry or overeat.

Guide to Farmers’ Markets Australia and New Zealand 2007Published by RMW Classic PublicationsLow GI eating means eating around 2–3 serves of fruit and at least 5 serves of vegetables a day. To many people, increasing their intake of fruit and veggies seems a tall order. Here’s a tip – try tempting your tastebuds with truly fresh, seasonal fruit and vegetables. You will not only taste the difference but get to talk to the person who grew the carrots, tomatoes, peaches or plums. Come Saturday or Sunday mornings in showgrounds, parking lots and town squares, check out your local farmers’ market with all the fun of the fair plus the best possible spin off – healthier eating for you and your family. This handy glove box guide (RRP $19.95) covers 80 markets in Australia and 20 in New Zealand.

Farmers’ markets have really taken off around the world and are the Number One tourist attraction in many areas. Produce can vary from stall to stall, so it’s always worth doing the rounds before you buy. Here are some websites to help you find one near you.

I notice that the GI for oatmeal varies. How can I find oatmeal with the lower GI?The most recent tests using the standardised method in healthy volunteers show that oatmeal porridge made from traditional, old-fashioned or raw rolled oats has a GI of around 58. If you use steel cut oats the GI is even lower, 52. Porridge made from instant, quick or minute oats has a GI of 82. Particle size matters (see December 2006 Food for Thought). The rule of thumb is to select minimally processed oats that still have the husk. They tend to be more yellow-brown in colour. And although they may take a little longer to cook, the flavour is great and the GI is low. You can also use them to make your own muesli or add them to your other recipes and baking to reduce the GI.

Does slow cooking raise the GI of a dish?The point of slow cooking (not over cooking) at a low temperature is to gently tenderise tougher protein ingredients like cheaper cuts of meat or chicken, which don’t have a GI. This tagine from The Low GI Diet Cookbook takes around an hour to cook and it has a low GI because it also contains low GI vegetables and dried fruit. Other ingredients that take time to cook such as legumes (pulses) are GI tested after they have been cooked (nearly an hour) and that’s the GI value given in the Shopper’s Guide to GI Values and on www.glycemicindex.com. The same goes for wholegrains like pearl barley. However it’s important not to overcook pasta. It’s al dente pasta that has a low GI. Overcooking boosts the GI.

Does it matter what flower my honey comes from?It does seem to make a difference where the bees have been buzzing. We know from research in Australia that honeys from the blossoms of specific nectar sources have a low GI. This includes iron bark honey (GI 48), stringy bark honey (GI 44), and yellow box honey (GI 35) and they have been termed ‘pure floral honey’ to differentiate them from honeys blended from a variety of nectar sources (‘commercial mixes’). These tend to have a medium GI (64). The difference in GI seems to be due to their sugar content and physical form. You can read the research report here (PDF 150 kb).

I have some questions about The Low GI Diet. On pages 80, 81 of the Australian edition should Dave's salmon read (4) and not (2), and why (6) vegetables and (3) fruit and not (5) and (2)? Also, do you have an easy way to relate the recipes to daily allowances and categories?

‘I think you are referring to the 2 fat serves in the evening meal and suggesting that this should read 4. I believe 2 is correct but can see how you may be confused,’ says author Kaye Foster-Powell. ‘The main source of fat in this meal is the olive oil dressing – 2 tablespoons of dressing is specified. We assume that the dressing is 50% fat and 50% vinegar so the dressing supplies 1 tablespoon or 20 ml of oil which is equivalent to 2 x 10 ml fat serves. The 6 vegetable and 3 fruit serves in Dave’s day reflects his higher energy intake. I can see that the text at the bottom of page 72 which states “Whatever your energy level, everyone needs to eat 5 serves of vegetables and 2 serves of fruit ...” is misleading in this regard and would more correctly be worded “…everyone needs to eat at least 5 serves of vegetables and 2 serves of fruit”.

Kaye Foster-Powell

I can’t say there is an easy way of relating the recipes to the daily allowances and food categories but I would look at the main ingredients and work from there. For example, Breakfast on the GO is basically milk and fruit. I’d count it as one serve of fruit and one of protein. Fruity Porridge Oats is fruit, oats, milk – probably 2 fruit serves, ½ carb serve and ½ a milk serve. Flipping ahead to Thai-style Tofu and Noodle Soup, basically I have noodles, tofu and vegetables. I can never get too many vegetables, so I don’t worry with calculating that. I get a bit under 100 g of tofu per serve, so that’s 1 protein serve and I get barely 1 carb serve in the 21 g of carbohydrate per serve.’

Low GI sugar If you have a sweet tooth, the good news is that biotech company Horizon Science has developed the world’s first totally natural low GI sugar (GI 51). The bad news is that it won’t be on a supermarket shelf near you until late 2008. We’ll keep you posted on the launch date along with the brand names it will be sold under worldwide, whether it will carry a GI symbol along with a special low GI recipe or two. We haven’t seen it or tasted it ourselves yet, but Dr David Kannar, chief scientific officer at Horizon tells us that: ‘It’s a honey-coloured, crystalline sugar that’s just as sweet as standard table sugar (sucrose) but with a slightly golden syrup flavour. In fact in blind taste tests so far the taste of the new low GI sugar was preferred over white sugar.’ As for using it in your favorite recipes, ‘tablespoon for tablespoon, you can use this low GI sugar in your cooking because it has the same bulk and texture as normal sugar,’ he said. ‘Think of it as an under-refined sugar that retains a lot of the organic nutrients from parts of sugar cane that traditionally have been discarded as waste during processing.’

Sugar CaneConvenience meals for the US and CanadaIncreasingly consumers want their grocery choices to deliver convenience, taste and health benefits. The new US and Canadian edition of The Shopper’s Guide to GI Values 2007 includes the latest GI values of 14 President’s Choice Blue Menu meals and 12 NutriSystem prepared and convenience meals along with serves sizes, available carbs and glycemic load. There’s plenty of choice for low GI meals in minutes all clinically tested by GI Labs in Toronto. It’s encouraging to see companies providing lower GI, lower fat, portion-controlled convenience foods for people with no time to cook. And it’s even more encouraging to see them invest in GI testing and making that information available to consumers in this handy, pocket-sized Shopper’s Guide. Pick up a copy from your local bookshop or Amazon to check out the values.

Where can I get more information on the GI symbol program?The GI symbol on a food is a guarantee that the stated GI value is reliable and that the food is a healthy choice in its food group. To earn certification, foods that carry the symbol must be a good source of carbohydrate and meet a host of other nutrient criteria including kilojoules (calories), total and saturated fat, sodium (salt), and where appropriate, dietary fibre and calcium. The GI Symbol Program is a public health initiative run by Glycemic Index Limited, a non-profit company whose members are the University of Sydney, Diabetes Australia and the Juvenile Diabetes Research Foundation.

Subscribe - it's free!To subscribe to GI News, simply click on the SUBSCRIBE link in the top right-hand column. Every 1000th subscriber receives a complimentary copy of The Low GI Diet Cookbook. Books for subscribers 24,000, 25,000 and 26,000 went to Seguin, Texas (US); Mullaloo, Western Australia; and Kitchener, Ontario (Canada) respectively courtesy of the publishers Marlowe & Company in the US and Hachette Livre in Australia.

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